Improving Consent, Efficiency, and Patient Satisfaction at Capital Digestive Care

Improving Consent, Efficiency, and Patient Satisfaction at Capital Digestive Care


Established in January 2009, Capital Digestive Care unified more than 50 physicians across the Washington metropolitan area in their desire to advance the delivery of care for patients suffering from all types of digestive health conditions. The practice now includes 60 physicians and 15 non-physician providers at 16 locations in the DC/Maryland area. Capital Digestive care performs nearly 50,000 procedures a year, including roughly 35,000 colonoscopies. 

In their ongoing effort to provide the best-in patient experience and outcomes, in September of 2016, Capital Digestive Care implemented EngagedMD's GI patient education and informed consent system, an e-learning service that uses short, interactive videos and comprehension questions to educate patients about the benefits, processes, and risks of colonoscopies and the associated anesthesia service as well as how to prepare for their procedure. In addition to improving bowel prep quality, the system tracks and documents patient compliance and comprehension and creates a thorough, auditable record of informed consent.

Ensuring True Informed Consent Reduces Risk

Comprehensive informed consent requires more than a brief description of possible complications. Patients must have a thorough understanding of the benefits, risks, alternatives, and processes in order to provide legitimate informed consent to a procedure. Many lawsuits are not the result of malpractice, but rather patients contending that they were not aware of or did not understand the risks of a given procedure. 

Unfortunately, there is often little time to adequately assess a patient’s understanding during an office visit. Furthermore, due to the routine nature of colonoscopies, many patients never meet with their physician until the day of their procedure. Since patients arrive for their colonoscopies after completing a lengthy and unpleasant bowel prep, they are unlikely to decline the procedure even if they do not fully understand the risks involved. 

Before implementing EngagedMD, Capital Digestive Care distributed surveys to nearly 200  patients immediately before their scheduled colonoscopy. The brief survey asked patients to answer questions about the procedure and its accompanying risks. The results of those surveys were eye-opening. 

“I was stunned by how poorly patients answered even the most basic questions,” says Michael Weinstein, CEO of Capital Digestive Care. “It shows that one five-minute in-office conversation is not nearly enough to fully educate patients.”

In contrast to the in-office model of patient education, the e-learning module provided by EngagedMD allows patients to walk through the videos at their own pace, and revisit each video as many times as they like. The comprehension questions at the end of each section serve to highlight key points and reinforce correct answers. All of this activity is thoroughly documented, creating an auditable record of informed consent.

Patients are asked comprehension questions throughout the module to reinforce key concepts and identify knowledge gaps

A survey of patients that completed the EngagedMD module through Capital Digestive Care showed a significant increase in comprehension. EngagedMD participants scored nearly 90% while the comprehension of the control group was just 63%. Additionally, among first-time patients who completed the EngagedMD module, 95% agreed or strongly agreed with the statement “I knew what to expect before, during, and after treatment.” Only 55% of those who did not participate answered in the same fashion.

EngagedMD users showed significantly better comprehension than nonusers of important concepts, such as bleeding risk

Standardizing Patient Education Protects Physicians and Increases Practice Efficiency

Like many large medical groups, Capital Digestive Care is composed of dozens of providers, each with their own office work patterns. Without a standardized process for administering and tracking patient education and informed consent, it is impossible to ensure that all patients at all locations have received the information that they need. EngagedMD eliminates the discrepancy in information and tracking from location to location. 

“Doctors, as a whole, like to think that their patients are different than all other patients. But the truth is, in large part, people are pretty similar. EngagedMD allowed us to make sure that we were disseminating the same information to everyone,” says Weinstein. 

EngagedMD integrates with GMed and other systems, providing seamless automated enrollment. Alternatively, providers or call staff can enroll patients manually, through a 30-second process on the web portal. Once patients have been enrolled in EngagedMD, the patient is sent an email with a link to the assigned module. EngagedMD automatically creates a documented audit trail of the patient education process which serves to keep providers apprised of patient compliance and protect the practice against a fraudulent lawsuit. 

Providing patients with the opportunity for at-home learning increases their confidence and saves physicians valuable time. 77% of patients using EngagedMD reported that the e-learning module answered questions that they would have otherwise had to ask their medical team. Covering the basics outside of the office also allows for enhanced and productive in-person consultations since the patient arrives well educated. Furthermore, since the patient can go back and review the videos at any time leading up to their procedure, EngagedMD drastically reduces the number of call-in questions. 

With Engaged MD, patients arrive for their procedure fully informed, ready to sign the consent and undergo the colonoscopy. Equally important, the practice is provided with documented patient education process data that may be used to prove consent, should it ever be required.

Better Education Leads to Better Bowel Prep and Cost Savings

Canceled procedures are costly for any practice. Not only do physicians lose the profit from the missed procedure, but cancellations also diminish returns on surgery center and physician time. 

A leading cause of canceled colonoscopies is inadequate bowel prep. An incomplete prep and resulting cancellation not only costs practices time and money but also severely inconveniences patients. Rescheduling a colonoscopy requires a patient to set aside another two days to complete the bowel prep and undergo the procedure. This poses a genuine hardship for patients who have already set aside that time in their schedule for the original procedure. Furthermore, rescheduling for a later date requires patients to undergo another round of bowel prep - a driving factor for patient dissatisfaction. Given the inconvenience of repeating the prep and rescheduling the colonoscopy, many patients opt to skip the procedure all together - putting themselves at increased risk of developing colon cancer. 

Completing the EngagedMD videos (or lack thereof) had a statistically significant effect on bowel prep adequacy

At Capital Digestive Care, the implementation of EngagedMD reduced inadequate bowel prep by over 50%. Capital Digestive Care’s baseline finding of an inadequate bowel prep rate was 2.07%, a relatively low rate among its peers. Among the patients that completed the EngagedMD colonoscopy module, the inadequate bowel prep rate was just 0.95% - a >50% decrease. This reduction represents 392 fewer inadequate preps per year for the practice. Since Capital Digestive Care loses approximately $786 in provider compensation  for every colonoscopy canceled due to inadequate prep, reducing the number of inadequate preps by 392 represents about $308,112 in increased distributable income  to the bottom line - an excellent ROI by any standard.  

Increased Patient Satisfaction: The Driver of Practice Success

Though patient satisfaction is not as easily trackable as the success of treatment or procedures performed, it is an undeniable driver behind practice success and sustainability. 

63% of patients participating in EngagedMD at Capital Digestive Care reported that using the module made them more satisfied with their care. One patient said, “I felt this learning system shows an ‘above and beyond’ aspect of my care that I was not expecting.” Another said, “It feels like the doctor cares enough about me to include this module in my care package.” Many patients reported that EngagedMD reduced their anxiety about the procedure and led to a better experience. One such patient said, “Being informed brings me a feeling of security and confidence in the doctor/medical team.

In addition to feeling that the practice was providing a superior level of care, 87% of patients enjoyed learning about their procedure through the EngagedMD module. “Well-designed portal. I felt the questions did a very good job evaluating the understanding of the material,” said one patient. “I liked learning about my procedure from the EngadedMD eLearning system because it taught step by step about my procedure,” reported another. 

91% of patients said that using EngagedMD was helpful to additional in-office consultations. Patient quotes include:

“It could be done at the time and place of my choosing; could be returned to if I had questions; sometimes things said in doctor's office are forgotten, and this was a good refresher.”
“It allowed me to gain information at my own pace. Sometimes you remember a question(s) you wanted to ask after you have left the doctor's office.”
“I like EngagedMD because it was extremely informative. I've had no contact with medical procedures and know how lucky I've been up to this point. I am completely ignorant of what this is about. I'm so ignorant, that before this procedure I wouldn't even be able to ask an educated question, other than, ‘So, what do I do?’ and ‘What is this about?’”

There’s Always Room for Improvement

Dr. Weinstein says, “It’s been a tremendous success, and we are working with EngagedMD to offer more modules for patients undergoing other GI procedures. The medical profession as a whole is often slow to adopt new processes, but I would encourage other practices to investigate EngagedMD. We all like to believe that we are already providing the very best in patient care, but there is always room for improvement and the ROI can be huge.”